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Clinical Case Management Specialist
2 weeks ago
The Clinical Case Management Specialist is responsible for assessing, planning, implementing, and coordinating case management activities to evaluate the medical needs of our members. This role involves face-to-face interaction with members, health care providers, and other stakeholders, as well as travel (at least 25% of the time) to various facilities and community meetings.
Responsibilities
This position entails conducting thorough assessments of member needs, utilizing clinical tools and information/data review, and collaborating with health care providers to develop comprehensive care plans. The successful candidate will apply clinical judgment to reduce risk factors and barriers, assess complex health and social indicators, and make referrals to clinical resources when necessary. Additionally, they will consult with supervisors and other stakeholders to overcome barriers and meet goals and objectives, present cases at case conferences for multidisciplinary focus, and utilize case management processes in compliance with regulatory and company policies and procedures.
Qualifications
To excel in this role, you will need:
- A minimum of 3+ years of clinical practical experience
- Minimum 2+ years of CM, discharge planning, and/or home health care coordination experience
- An active and unrestricted Compact RN license in OH
Preferred qualifications include excellent analytical and problem-solving skills, effective communication, organizational, and interpersonal skills, proficiency with standard corporate software applications, and bilingual capability (Spanish). Certification as a Case Manager is preferred, but not required.